It is difficult to imagine how the mental health of survivors of the 1994 Genocide against the Tutsi, and those who witnessed it, was affected, and the aftereffects they had to deal with in the years that followed. Thirty-one years later, many are still grappling with these effects, as is often seen during Genocide commemoration events, where people are overcome by trauma and break down. Nobody understood these challenges better than mental health clinicians at the time. Among which, Josée Nyamutamba Nyetera, a seasoned therapist and one of the pioneers of mental health care in Rwanda after the Genocide against the Tutsi. Nyamutamba has devoted her life to the healing and recovery of those impacted by trauma and psychological problems. At 77, her journey has been marked by resilience and a deep sense of duty—something that began long before the 1994 Genocide. It was in the aftermath of the genocide that her commitment to helping others found its true calling. Now a pivotal figure in Rwanda's evolving mental health landscape, Nyamutamba reflects on her personal history, the country’s recovery from devastation, and her role in shaping the nation’s mental wellness in an interview with The New Times. Fleeing Rwanda at an early age Born in Gasetsa, Eastern Province, in 1948, Nyamutamba was the seventh of nine children. She began her education in Rwanda, but as political turmoil and ethnic tensions grew—fueled by the government at the time—her family was forced to flee the country. Nyamutamba’s journey of survival and education took her through Burundi and Tanzania, where she eventually pursued nursing and midwifery training, before continuing to other countries like many Rwandans in exile at the time. ALSO READ: Solid Minds, Mastercard Foundation partner to revolutionise mental health support for students in Africa I did my primary school here in Rwanda, and then I started secondary school here. I did my first two years of secondary education in Rwanda, and then I had to flee and follow my parents because they had left me in Rwanda, she explains. I had to follow them, but I didn’t go straight to them. I first went to Burundi, where my sister was, and tried to study again, she adds. After a few months, her father brought her to Tanzania, where she started her nursing training and began her career in healthcare. Her journey took her to Uganda, where she worked in various medical roles before moving to Zaire (now DR Congo) in the 1970s. A calling beyond hospital walls Despite her success in the medical field, Nyamutamba felt a growing sense of purpose to help those beyond the walls of the hospital. By 1988, she began to feel a “call” to do more—something that transcended traditional healthcare. It was not clear what this mission was, but it was undeniable. This sense of duty would come into sharper focus after the 1994 Genocide, when Rwanda’s trauma was compounded by the loss of over a million lives and the destruction of countless families. It was something else stronger than me, but I didn’t realise what it was, she says, reflecting on the turning point in her life. “Sometimes I could even go into the city just to see if there was anyone needing my help. In what way, I don’t know. I could not understand until I came back to Rwanda.” When Nyamutamba returned to Rwanda after the Genocide against the Tutsi, this inner drive to help those in need persisted. In 1995, she joined Care Australia, initially working as an interpreter for an Australian nurse in charge of an unaccompanied children’s centre. This role allowed her to witness first-hand the immense psychological scars left on Rwandans by the genocide. I worked for Care Australia. I was just doing interpretation. I was working with an Australian nurse. They had an unaccompanied children’s centre at Umushumba Mwiza, Nyamutamba recalls. I think we had about 100 children to take care of, and I was just doing interpretation for her for a few months. Then, when she left, I replaced her. First encounter with trauma In the early months of 1995, Nyamutamba’s work took an unexpected turn. She accompanied a psychologist from Australia to a locality in Remera, where they met a traumatised nun. This encounter marked her first direct experience with trauma survivors—an experience that would shape the rest of her career. It was my first time seeing a traumatised person. It was right after the Genocide, because it was in March 1995, Nyamutamba remembers. ALSO READ: Resilient women, resilient minds: celebrating women in mental health It was also during this time that she met Fred Kasozi, a Ugandan working for Save the Children UK, who became a key inspiration for her. Kasozi’s compassion and dedication to helping Rwandan children deeply impacted Nyamutamba, leading her to reflect on her own desires and motivations. She prayed for guidance, seeking to understand the source of the calling she had been feeling. A new mission to become a trauma counsellor Nyamutamba’s life took another decisive turn when the Australian nurse and psychologist she was working for—who she remembers as Jane—recommended her for training as a counsellor. Jane had recognised Nyamutamba’s potential and recommended her for the training programme. Despite her surprise, Nyamutamba accepted, and this decision marked the beginning of her career as a trauma counsellor in post-genocide Rwanda. I was just surprised. She said, 'I'm going tomorrow. Go home, change yourself and come back. You are going to UNICEF and you have a meeting there,' Nyamutamba recalls. “She told me, ‘I think you can be a good one.' This recommendation led her to UNICEF, where she underwent intensive training in trauma counselling. Alongside others, Nyamutamba learned about the psychological impact of the genocide and began to acquire the skills needed to help the survivors. The training was both theoretical and practical. We started with theory, and slowly by slowly, we had to prepare ourselves to go to the field, she says. Building mental health system On June 26, 1995, the Ministry of Health, Ministry of Rehabilitation, and UNICEF officially launched the National Trauma Centre in Kimironko, City of Kigali. As the trauma counsellors completed their training, Rwanda was beginning the long and arduous process of rebuilding its healthcare system, including mental health services. At that time, the Government of Rwanda, in collaboration with WHO, created a document entitled the National Mental Health Policy with the aim of responding to the unprecedented challenge posed by the genocide, she explains. The centre began as a mobile clinic, providing crucial mental health support to those affected by the genocide. Slowly but steadily, Rwanda’s mental health infrastructure expanded, with local clinics and community-based services emerging to meet the growing demand for care. ALSO READ: Rwanda steps up mental health efforts to combat suicide The Government also established the National Trauma Centre to address the magnitude of needs caused by post-traumatic syndromes. With the support of Swiss Humanitarian Aid, the hospital in Ndera—managed by the Congregation of Charity Brothers—became a training centre. The late Dr. Naasson Munyandamutsa and others began recruiting and training individuals to provide counselling services. They also reached out to patients who were in hiding or still wandering and began treating them. At that time, they had virtually no facilities or medicines. They were simply improvising. “I remember there was one nurse who returned from Burundi. He had been working at a mental hospital in Burundi” Nyamutamba recalls. “He started looking for some medicine to begin working. At that time, phase one was sensitisation. After sensitisation, there was a demand for clinics,” she adds. After training and sensitising the public, clinics were needed because people were beginning to realise they needed care and were seeking help. We started with seven people, and then two or three more joined. We had a house in Kimironko... we were renting, and UNICEF really helped us. They paid for everything, even down to the pens and paper. We worked 3 years with UNICEF, then 1999 the National Trauma Centre became the Psycho-Social Consultation Service (PSCS) in the Ministry of Health, Nyamutamba recalls. We each had tape recorders. When we went into the field, we would record ourselves for supervision. The creation of the National Trauma Centre was a significant step in the country’s recovery. Nyamutamba remained deeply involved in training and supporting a new generation of mental health professionals. In 2009, she retired but continued to serve with a local NGO and kept undergoing training with the ASMSR. In 2021, she Joined Solid Minds Counselling Clinic where she works a consultant helping families, children, and people struggling with tobacco addiction. A challenging landscape While Rwanda made significant progress with the establishment of the trauma centre in 1995, the need for mental health services remained overwhelming, as people continued to grapple with trauma. Post-genocide, Nyamutamba says it was in 2002 that they started seeing severe reactions during the commemoration period, as many were deeply affected by trauma. “Then, we were very few. We didn’t know what to do. Sometimes, you’d see a bus arrive full of schoolgirls or boys—16 at once. They would be unconscious or conscious but extremely sad and emotional. It was difficult to handle,” she recalls. ALSO READ: 35% of Genocide survivors have mental health problems – RBC Nyamutamba says that sometimes on April 7, when the commemoration begins, or April 13, when we end the commemoration week, they would work from 6 p.m. until 5 a.m. the next day, sleep for an hour, and then return to work the entire day again. “It was very hard. Sometimes we would go to KIE (Kigali Institute of Education) and bring in students. We trained policemen, the Red Cross, and the Association of Student Genocide Survivors (AERG), so they could help us during the commemoration—and they did quite well,” she recalls. “We used to set up tents. They would help us with initial care, and those in worse condition would be taken to the clinic. At the Psycho-Social Consultation Service (PSCS), it was too much for us, but as the years went by, we learned to decentralise,” she says. Nyamutamba highlights the progress made in destigmatising mental health challenges in Rwanda, noting that more people are now willing to seek help for conditions that were once hidden or ignored. Before, it was something people didn’t talk about. Now, people have started to open up, Nyamutamba observes. Previously, it was hidden...people should demystify mental health. No one should be stigmatised; it is an illness like any other, which can be treated and cured. Mental health challenges Despite these advancements, Nyamutamba says challenges remain, especially as mental health issues have evolved—particularly among young people. The pressures of modern life, including the pervasive influence of social media and increased stress, have raised concerns about the mental health of Rwanda’s youth. Drug abuse, often used as a coping mechanism, has also become a growing issue. Awareness increases the number of people who seek help. That’s one thing. But then, some people look for answers elsewhere, like in smoking marijuana or using drugs. Drug abuse is an emerging issue in the country, Nyamutamba notes. She explains that people trying to cope with modern-day pressures may turn to drugs, but sometimes it’s the mental illness that leads people to use drugs in the first place. “Sometimes the drug comes first; other times, the illness comes first, and people use drugs to calm down. But once drugs are involved, things often worsen,” she says. ALSO READ: Depression: There is no shame in seeking help “The issue of drug abuse is becoming a challenge. Today, we have hospitals such as Ndera, Kinyinya, the rehabilitation centre in Huye, Icyizere, and others, including here at Solid Minds, where we have specialists trying to address these cases,” she says, adding that drug abuse is connected to many factors. However, one of the less-discussed challenges is the situation of children who were forced to grow up too early because they were orphaned. “We have children who never had parents and were not allowed to be children. They became adults too soon, and that can weaken a person. The effects show up later,” she explains. “There are many children who had to be responsible for their siblings. They had to behave like adults, take care of their brothers and sisters, and sometimes sacrifice their education. This deeply affected many young people.” Nyamutamba, a mother and grandmother, commends the government for its efforts over the past three decades, particularly the establishment of the Genocide Survivors Fund (FARG), which she says has helped cushion survivors from some of the pressures they faced. “We are glad the government has done a lot in this area—providing shelter and basic needs to these children. That was a huge achievement. FARG has helped immensely.” “If FARG didn’t exist, I don’t know where this country would be. There were so many children to care for, and now they are giving their testimonies,” Nyamutamba says. Today, those young survivors have become men and women. Some are married and have children. “It went well. I cannot fully express what FARG meant. It came at the right time. FARG was like a family that parented those children properly.” A legacy of healing, prevention Nyamutamba, a member of the Association Santé Mentale Suisse-Rwanda (ASMSR), continues to work with Solid Minds Counselling Clinic, a private outpatient mental health clinic that provides individual support, training, and organizational consultation. Her message is clear: mental health is vital to national progress and should be treated with the same importance as physical health. For those suffering, there is no shame in seeking help. If you are aware, it is the beginning of treatment. Because if you don’t know what’s going on inside you, you cannot seek care, Nyamutamba stresses. It shouldn’t be stigmatising. It shouldn’t be shameful. We are all candidates—it can happen to you, to me, and to anyone. Looking to the future, Nyamutamba is hopeful for Rwanda’s continued growth in mental health care, even though much remains to be done. Her work has paved the way for more services, greater awareness, and more opportunities for healing. Today, we see many young people getting sick... We need better organisation. That’s why at Solid Minds we work with universities, so we can reach these young people, she says. Nyamutamba appreciate the government’s initiative of introducing the faculty of psychiatry and clinical psychology in the university of Rwanda. It gives hope that our healing journey is progressing well. A lifelong healing commitment Nyamutamba’s journey from a nurse in Tanzania to a senior in Rwanda’s mental health landscape is a testament to the power of answering the call to help others. Her dedication to healing, deep empathy for those suffering, and unwavering commitment to Rwanda’s recovery are an inspiration to many as the country continues to rebuild and overcome the scars of its tragic past. Today, Nyamutamba remains an invaluable resource, guiding the nation’s journey toward healing and offering hope to those still suffering in silence.
